Half MD talks about his internal medicine rotation:
One of the frequent complaints about the internal medicine clerkship is that rounds take entirely too long. My own team would routinely spend about three hours going through a census of only 20 patients. Some of my classmates got thrown into groups which would take five hours every day to run through the list””and that’s after all of the pre-rounding has been completed, orders filed, test results analyzed, and patients reassured.
Of course, the time it takes for rounds would be dependent on how efficient the attending or resident was. Three to five hours for 20 patients sounds about right. At least it was for me 7 years ago when I was a resident.
I wonder if there is more urgency to rounding now, with the pressure that hospitals put on attendings to quickly turnover and discharge patients.
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{ 4 comments }
I’m a 3rd year medical student, and I just completed my 12 week internal med rotation – let me tell you, it is HIGHLY attending/upper level resident dependent. On one service, we spent two weeks going through a 20 pt census from 8:30 to roughly 12:30 every day. Then, after the switch, we would often get done at 10-10:30 for the next two weeks. This kind of variability was also present on different services in internal medicine, and even on my Psych rotation. the limiting factor seems to be who we decide to go personally visit, and who does the talking (the longest rounds being when we visit EVERYONE and the upper level (or even interns) are allowed to run the show). Oh and of course, my fellow med students and I would be coming in every day at around 5:45-6am to pre-pre-round before the residents so we can help them pre-round etc…
In my internal medicine rotation, the attendings who took longer tended to teach more. It also meant the more complicated patients.
I found that anxiety levels of the upper levels are a predictor of knee pain from standing on rounds for hours. The more relaxed and experienced upper levels move more quickly. I had the good fortune in 4 months of my internship to have a resident who was coming back to finish internal medicine residency after 10 years as a small town GP. Our attending was the senior “old man” of the department. They were both savey, wise, and comfortable with their judgements–both of patients and interns. After close oversight at first to get our measure , they stepped back, left us and the students to get the day to day done without interference, just hanging in the wings to help out if needed and teaching with as few words as possible. It was the first time up to then that actually enjoyed clinical medicine.
Also, from a year that is a blur to me now 25 years later, it is the few words of that senior attending and that resident that still are with me in my clinical work now. All the hours of droning of the others are just a background buzz behind memories of aching knees and fighting a need for sleep.
Of course, consider the source of the article; a med student who clearly wants to be a surgeon and has spent a good deal of time trashing other specialties. 3 hours for 20 patients is appropriate if the discussion is based on learning rather than on things like discharge planning.
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